MEDICARE: DR. ANNETTE WILLIAMS LYNN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	15799	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194792010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE WILLIAMS LYNN M.D.

Provider Business Mailing Address
First Line	:	1706 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2410
Country	:	US
Telephone Number	:	803-771-7506
Fax Number	:	803-771-9455

Provider Business Practice Location Address
First Line	:	1706 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2410
Country	:	US
Telephone Number	:	803-771-7506
Fax Number	:	803-771-9455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	06/29/2010

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